Poor sleep, missed meals, low mobility, stress in hospitals may lead to readmission

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12/3/2018

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Dr. Shail Rawal (L), a physician at Toronto Western Hospital, and Dr. Amol Verma, a physician at St. Michael’s Hospital, co-authored the study which suggests it might be possible to improve patient experience and outcomes at the same time. (Photo: GEMINI)

Patients who experience disturbances in hospital, in their sleep, mobility, nutrition or mood may be more likely to be readmitted up to 30 days after discharge. This is the main finding of a new study led by UHN and St. Michael's Hospital that looked into patient experience during hospitalization. The study was published today in JAMA Internal Medicine.

All 207 patients who participated in the study at St. Michael's and at Toronto Western Hospital (TW) reported disturbance in at least one of those four categories during their stay in hospital.

Some 65 per cent of the patients reported disturbance in more than one category and about 30 per cent reported disturbances in three or four categories. Those with disturbance in three or four categories were classified as patients with "high trauma of hospitalization" and had a 16 per cent higher risk of readmission to hospital after discharge.

"This study gives us a snapshot of different dimensions related to being in hospital and how they can affect recovery," said Dr. Shail Rawal, physician at TW and lead author of the study.

"The results suggest that enhancing our patient-centred healing environment through initiatives that address these issues may go a long way in improving care. And there are gains that can be made without much pain."

As an example, changes such as minimizing alarms at night, offering ear plugs and eye masks for patients may help improve sleep quality in hospital. Initiatives to get patients out of their beds and making food more accessible could also help with mobility and nutrition.

According to Dr. Rawal, these are simple interventions that are being considered to improve the experience of hospitalization and also lower the risk of readmission.

A data platform called
GEMINI that collects information related to hospital stay, such as lab results, initial diagnosis, etc., was used to show that the patients with higher disturbance rates were not sicker than those with low disturbance rates.

The questionnaire used in the research was based on existing evaluation tools.

It measured the quality of the patients' sleep through a series of questions related to falling asleep and feeling restful and refreshed after sleep. It evaluated mobility based on how active the patients perceived themselves to be during their hospital stay.

Nutrition was measured based on whether the patients' meals were disturbed, interrupted or missed. Patients' moods were based on self-evaluations of feelings of anxiety or depression at time of discharge. The most common disturbances were in mobility and nutrition.

"Everyone who works at a hospital knows intuitively that the disruptive hospital environment has a profound impact on patients, but with this research, we have a clearer picture of the scale of the problem and we now know that it could affect patient outcomes," said Dr. Amol Verma, a physician at St. Michael's who co-led the study and co-founded GEMINI.